Primary care providers and pediatricians may be less confident than child and adolescent psychiatrists in their ability to tell whether irritability in young patients is normal or could be linked to deeper mental health issues, a new study suggests.

Further, in their study, researchers found that primary care providers and pediatricians were more likely to prescribe medications when they thought there was a problem, while psychiatrists were more likely to start with behavioral therapy.

More than moodiness

Because of the issues and challenges that children face, such as bullying, it’s important for health care providers to be able to identify children and adolescents whose problems go deeper than typical moodiness, says Anna Scandinaro, a medical student at Penn State College of Medicine. More education for these providers may be a good place to start.

“We need to start asking if there’s anything we can do to prevent these things from happening,” she says. “There’s a lot of concern right now about children’s mental health, and we wanted to compare how different practitioners go about trying to figure out who’s going through normal irritability and who may benefit from additional treatment.”

Irritability is a normal part of a child’s development, but it can also be a symptom of mental health disorders like disruptive mood dysregulation disorder. It can be difficult for doctors to tell the difference between acute irritability—an adolescent being grumpy for a few days because he was grounded, for example—and chronic irritability, which could signal possible problems with mental health.

Parents: Follow your gut

Researchers recruited participants for the study from a large, academic medical center and included family medicine, pediatric, and psychiatry providers. Researchers interviewed 17 providers about how they define irritability in their school-age patients, how they evaluate irritability, and how they differentiate between normal and abnormal irritability, among other questions.

“We found that family medicine physicians and pediatricians feel as though they don’t have the resources and the training they need to effectively evaluate irritability in the clinic setting, especially in the limited amount of time that they have,” Scandinaro says.

“But at the same time, there is a national shortage of child and adolescent psychiatrists, increasing the need for primary care providers to be more comfortable in determining who needs to see a specialist. So even though the study was preliminary, it shows we need to improve education for primary care providers.”

Further, while family medicine providers looked for anxiety and problems in school as symptoms of irritability, psychiatrists tended to check if children exhibited a negative mood or a hard time dealing with frustration. Family care providers also reported being comfortable prescribing medications but would be more likely to refer patients to a specialist if they needed stronger medications and treatment.

All the participants agree that a lack of time with patients, as well as few concrete guidelines about what defines irritability and how to treat it, makes diagnosing patients more difficult.

The findings, which appear in Primary Care Companion for CNS Disorders, suggest that primary care providers may not be confident evaluating irritability, even though the majority of children receive mental health care in a primary care setting, according to the National Institute of Mental Health.

Additional training and education may help primary care providers and pediatricians gain more confidence in diagnosing their younger patients, Scandinaro says.

“A possible next step could be to create an educational tool that could be used as a quick way for primary care providers to help evaluate their patient and to help them decide if it’s normal irritability or something that requires them to see a specialist.”

It’s also important for parents to follow their gut when they notice something that seems wrong with their child, and they should always talk to their doctor if concerned.

“If you think that something is going on, make it a priority to talk to your doctor about it. Don’t be afraid to mention it if something seems not to be right. Irritability doesn’t always mean that the child is bipolar or has a severe mental illness, and medication doesn’t always have to be the first option. But it’s important to talk about it.”

Usman Hameed, assistant professor of psychiatry, and Cheryl A. Dellasega, professor of medicine and humanities, also participated in the research. A Qualitative Research Initiative Award helped fund the work.

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